Scripties UMCG - Rijksuniversiteit Groningen
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Outcomes of the failure of selective nonoperative management of penetrating abdominal trauma

(2016) Joosten, J.J. (Hanneke)

Introduction: Over the past five decades there has been a shift from mandatory operative
exploration to selective non-operative management (SNOM) in penetrating abdominal
trauma(PAT). Besides all the proven benefits of SNOM, the main concern is the potential
harm in patients who fail SNOM and eventually experience a delay in treatment. The aim of
this study is to investigate if delayed surgery due to failed SNOM is associated with adverse
effects in PAT patients.
Methods: All patients presenting at the Trauma Centre of Groote Schuur Hospital, Cape
Town in a 13-month period (05/15-06/16) were included. Patient groups were divided in
patients who went immediately for surgery and patients who failed SNOM and then had
surgery. Outcomes included mortality, morbidity rate and length of stay.
Results: Of 485 patients, 219 (45%) were managed by SNOM of which 26 (12 %) failed the
observation period and 266 (55%) with immediate surgery. The median time to OR was in the
immediate surgery group 5 hours (Q1-Q3 2-8) and in the failed SNOM group 45 hours (Q1-
Q3 27-68). Mortality was only observed in the immediate surgery group. There was no
difference in the number of patients who had complications (failed SNOM 31% vs. 37%
p=0.71), or in length of stay (failed SNOM median 7(5-10) vs. 7(5-12) p=0.95)
Conclusion: Under a structured clinical protocol, the delay does not cause preventable
mortality, morbidity or length of stay. Nevertheless further research has to be carried out to
emphasize our results.

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